Association between nutrition protocol with Clostridium butyricum MIYAIRI 588 and reduced incidence of Clostridioides difficile infection in critically ill patients: a single center before- and-after study.

Introduction: Clostridioides Difficile infection (CDI) is associated with high mortality. Clostridium butyricum MIYAIRI 588 (CBM) is a probiotic, reported to suppress proliferation of C. difficile. This study aimed to assess the influence of implementing a prophylactic nutritional protocol with CBM in reducing CDI incidence in critically ill patients.Methods: Adult critically ill patients admitted to the intensive care unit (ICU) between 2008 and 2012 were enrolled in this single-center observational study. The original nutrition protocol was introduced in 2010. Patients admitted between 2011 and 2012 (nutrition protocol group) were compared with those admitted between 2008 and 2009 (control group). Primary outcome was CDI incidence during ICU stay. Results: There were 755 and 1047 patients in the control and nutrition protocol groups, respectively. The median ages of the control and nutrition protocol groups were 61 and 63 years old, respectively (p=0.05). There were 14 (1.9%) patients with CDI in the control group, and 1 (0.1%) patient in the protocol group (P ＜0.01). The length of ICU stay was 7 days in the control group and 6 days in the protocol group (p=0.01). Univariate analyses of relative risk for CDI showed that nutrition protocol was significantly related to CDI risk reduction (0.05 [0.01-0.39], p＜0.01). Conclusion: The nutrition protocol using C. butyricum may be associated with a reduction in CDI in critically ill patients.